choosing wisely -- tests to avoid in kids

choosing wisely came out with 10 tests/treatments that pediatricians/fam practice/ER providers should question (see http://www.choosingwisely.org/wp-content/uploads/2014/03/AAP10things-march2014.pdf ). nothing very surprising.

1. not use antibiotics for apparent viral infection (sinusitis, pharyngitis, bronchitis) -- still used too much, though rates have fallen
2. not give cough/cold remedies to kids under 4
3. not do CT for minor head injuries. clinical observation often sufficient and less radiation.
4. not do neuroimaging in kid with simple febrile seizure
5. not routinely do abdominal CT in kids with abdominal pain (again, too much radiation and often risks>benefits)
6. no advantage to high dose steroids for prevention/treatment of bronchopulmonary dysplasia in premies
7. not order IgE screening panels for food allergies without reasonable medical history (too many false positives: eg, 8% of population test positive for peanut allergy, but 1% are really allergic)
8. not use acid blockers or motility agents (eg metoclopromide) routinely in reflux (GER). GER is normal in infants and should not be treated unless affecting growth/resp sx. not usually necessary to do GI tract imaging to diagnose.
9. not do surveillance urine cultures to detect asymptomatic bacteruria
10. not routinely use infant home apnea monitors to prevent SIDS (may be reasonable if infant at risk for apnea or cardiovasc events).

Comments

Post a Comment

if you would like to receive the near-daily emails regularly, please email me at gmodest@uphams.org

Popular posts from this blog

cystatin c: better predictor of bad outcomes than creatinine

  another article found significant discordance between creatinine and cystatin C in assessing renal function,  finding that the latter correlated most strongly with both renal and non-renal adverse clinical outcomes (see   ckd cystatin c better than creat AJKD2023  in  dropbox or doi: 10.1053/ j.ajkd.2023.04.002)   Details: -- 158,601 adults who were in the Stockholm Creatinine Measurements (SCREAM) project and had testing of creatinine and cystatin C on the same day during a healthcare encounter, from 2010-2018     -- >400,000 outpatient tests were done for both creatinine and cystatin C levels -- mean age 62, 48% female -- mean eGFR by creatinine (   eGFR cr ) 80; mean eGFR by cystatin C ( eGFR cys  ) 73 -- mean stage of renal insufficiency: 39%  eGFR cr   90+; 38%  eGFR cr  60-89; 12%  eGFR cr  45-59; 7.1%  eGFR cr  30-44; 3.2%  eGFR cr  15-29, 0.7%  eGFR cr ...
Read more

diabetes DPP-4 inhibitors and the risk of heart failure

the FDA just came out with a safety alert about 2 DPP-4 inhibitors and the increased risk of heart failure (released 04/05/2016)(see  http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm494252.htm?source=govdelivery&utm_medium=email&utm_source=govdelivery ​ ). details: --saxagliptin and alogliptin were singled out because of 2 clinical trials in diabetic patients with heart disease. in each trial more patients taking these meds were hospitalized for heart failure vs those on placebo     --in the saxagliptin trial: 3.5% were hospitalized for heart failure (vs 2.8% on placebo). risk factors included prior heart failure or kidney disease     --in the alogliptin trial: 3.9% were hospitalized for heart failure (vs 3.3% on placebo) --recommendation by the FDA:     -- we should consider stopping these drugs if the patient develops heart failure ...
Read more

UPDATE: ASCVD risk factor critique

I decided to do an extensive update of my prior ASCVD (atherosclerotic cardiovascular disease) risk analysis and critique of risk calculators, with much more information about the “non-traditional” risk factors. I felt that there should be more data/clarification, since I think we are really undertreating/not preventing the most common cause of death by relying on the current ASCVD risk calculators   -- Cardiovascular risk models:      -- many of us rely on the various cardiovascular risk models to determine the appropriate approach to patients, and these are often integrated into the electronic medical records      -- these risk models have several very important limitations:          -- they are typically based on community data, eg from the Framingham study etc. But, in clinical practice, we are dealing with the individual and not the community:          ...
Read more